Document Detail

Lean thinking in healthcare: a realist review of the literature.
MedLine Citation:
PMID:  20724397     Owner:  NLM     Status:  In-Process    
OBJECTIVE: To understand how lean thinking has been put into practice in healthcare and how it has worked.
DESIGN: A realist literature review. Data sources The authors systematically searched for articles in PubMed, Web of Science and Business Source Premier (January 1998 to February 2008) and then added articles through a snowball approach.
REVIEW METHODS: The authors included empirical studies of lean thinking applications in healthcare and excluded those articles that did not influence patient care, or reported hybrid approaches. The authors conducted a thematic analysis based on data collected using an original abstraction form. Based on this, they articulated interactions between context, lean interventions, mechanisms and outcomes.
RESULTS: The authors reviewed 33 articles and found a wide range of lean applications. The articles describe initial implementation stages and emphasise technical aspects. All articles report positive results. The authors found common contextual aspects which interact with different components of the lean interventions and trigger four different change mechanisms: understand processes to generate shared understanding; organise and design for effectiveness and efficiency; improve error detection to increase awareness and process reliability; and collaborate to systematically solve problems to enhance continual improvement.
CONCLUSIONS: Lean thinking has been applied successfully in a wide variety of healthcare settings. While lean theory emphasises a holistic view, most cases report narrower technical applications with limited organisational reach. To better realise the potential benefits, healthcare organisations need to directly involve senior management, work across functional divides, pursue value creation for patients and other customers, and nurture a long-term view of continual improvement.
Pamela Mazzocato; Carl Savage; Mats Brommels; Håkan Aronsson; Johan Thor
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-08-19
Journal Detail:
Title:  Quality & safety in health care     Volume:  19     ISSN:  1475-3901     ISO Abbreviation:  Qual Saf Health Care     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101136980     Medline TA:  Qual Saf Health Care     Country:  England    
Other Details:
Languages:  eng     Pagination:  376-82     Citation Subset:  H    
Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
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